Inspection on 01/09/06 for Derwent House

This inspection was carried out on 1st September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Derwent House 30/09/09

Derwent House 17/09/08

Derwent House 10/10/07

Derwent House 06/12/05

Derwent House 16/05/05

Derwent House 05/10/04

Derwent House 21/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Derwent House Ulverston Road Newbold Chesterfield Derbyshire S41 8EW Lead Inspector Denise Bate Unannounced Inspection 1st September 2006 09:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Derwent House DS0000035815.V308804.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Derwent House DS0000035815.V308804.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Derwent House Address Ulverston Road Newbold Chesterfield Derbyshire S41 8EW 01246 347515 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.derbyshire.gov.uk Derbyshire County Council Vacant Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Derwent House DS0000035815.V308804.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th December 2005 Brief Description of the Service: The Home is situated in a busy residential area, close to local shops and services and on direct bus routes to Chesterfield town centre. The home is spread over 3 floors for up to 40 residents, all in single bedrooms, and with a lift to help access to the upper floors and a call system throughout the building in case of emergencies. There are assisted bathroom and toilet facilities on all floors and the home has several lounge areas on the ground floor, and smaller sitting areas on other floors. The home has a large garden that is easy to get into. A short stay respite service is available and a key worker system has been developed to help plan individual care with residents. Fees are £364 per week for permanent service users, with a range of prices for short term care service users. Additional charges are made for hairdressing, chiropody, newspapers and toiletries. Derwent House DS0000035815.V308804.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over nine hours. During the inspection eight service users, two relatives, and seven staff members were spoken with. The manager and a deputy manager were present during the inspection and provided assistance and information. Written information was provided by the manager prior to the day of inspection. A number of records were examined, including risk assessments and care plans, health and safety documentation, staff files, staff and resident meeting minutes, medication records and Regulation 26 visit records. Three service users were case tracked and additional care planning documentation was seen for some other service users. A tour of the building took place. What the service does well: What has improved since the last inspection? A manager has been appointed and has been in post for some months. The home have developed a programme of activities, entertainment and outings. Decoration has taken place in 17 bedrooms, in the foyer, and there have been new carpets on the first and second floor landings. In addition a hairdressing room and an activities room has been established and decorated. A new front door has been provided as required at the last inspection. Minor items identified with by the Environmental Health Officer have been complied with. Derwent House DS0000035815.V308804.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Derwent House DS0000035815.V308804.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Derwent House DS0000035815.V308804.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Assessments are done by care managers or other professionals based in the community. Some assessment information was not in sufficient detail to ensure the care provided by the home could meet service users’ needs appropriately. EVIDENCE: Assessments are carried out in the community by social workers and care managers and copies were seen on the care planning documentation of case tracked service users. Potential new service users are invited to spend a day at the home with their relatives but the formal record of these visits does not include detailed verification of assessment information. Information on one short term care service user admitted as an emergency did not appear to contain sufficient information to verify whether the home could meet the service users needs, which could impact on the quality of care that could be Derwent House DS0000035815.V308804.R01.S.doc Version 5.2 Page 9 provided within the home. It appeared that the assessment could have arrived after the service user had been placed. The home does not provide intermediate care so standard 6 does not apply. Derwent House DS0000035815.V308804.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans relating to personal and social care needs of service users are sometimes not completed in sufficient detail to direct and inform staff on how individual needs should be met. Service users are encouraged and supported to be independent and to exercise choice and are treated with dignity and respect. This contributes to the enhancement of service users’ everyday lives. EVIDENCE: Work has been done to create a consistent format for care planning. Some service users had signed documentation indicating that care plans had been discussed with them. All case tracked service users had personal service plans, daily logs, assessment forms for nutrition and tissue viability, risk assessments, and monthly summaries. The personal development plans were very brief and did not reflect the individual needs and preferences of service Derwent House DS0000035815.V308804.R01.S.doc Version 5.2 Page 11 users in detail nor provide comprehensive guidance to staff on how needs were to be met, e.g. daily routines. Detailed daily logs are kept. The inspector was informed that formal reviews take place, but there were not copies on the files of service users’ case tracked. The information on the pre-inspection questionnaire did not include information relating to dependency levels, although it was clear from other information provided and from discussion on the day of inspection that the home do have service users who have dementia or confusion, and several who have high physical needs, sometimes requiring two members of staff to transfer. It was also noted that some service users have recently been moved nursing care. Discussion with staff clearly identified that they were aware of service users individual needs and preferences, but as outlined above, this was not evident from personal service plans. As detailed in the ‘Staffing’ section of this report, staff work extremely hard to ensure service users care needs are met, and there is some frustration that there is insufficient time to spend on some tasks, e.g. bathing, nor to spend one to one time with service users. However, all service users and relatives spoken to were very complimentary about the standard of care they receive and indicated that they were treated with dignity and respect. One service user commented ‘I am very happy here’, and another said that they staff always ‘did the best they could’. Relatives felt that communication with the home was good and they were kept informed of any matters relevant to the service users circumstances. There was discussion around the needs of one service user and it was not clear whether a variation should have been applied for. This matter will be discussed further outside the inspection process. It was reported that the home has very positive relationships with the local GPs who give a very good standard of medical care. Matters relating to health needs are routinely noted on daily logs, and were seen in the monthly summaries although some summaries were brief. The administration of medication was inspected and records of case tracked service users found to be satisfactory. The home has a separate medication room with the medicines trollies, fridge and controlled medication cupboard. One trolly is used for morning and lunchtime medication, and one is used for tea and evening medication. Derbyshire County Council have recently introduced a new medicines code for their residential homes. Some comments had been made on a routine visit by the prescribing pharmacist regarding the recording, e.g. opening date on eye drops, not leaving any gaps in the MAR sheet records. The inspector was informed that these matters had been complied with. The inspector was informed that all staff administering medication had appropriate training. Derwent House DS0000035815.V308804.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities are provided that generally suit the expressed preferences of service users. Regular outside contacts are encouraged and supported. This assists in contributing to a pleasant atmosphere and the overall high level of satisfaction for service users. Dietary needs of service users are catered for with a balanced and varied selection of food available that meets service users’ tastes and choices. EVIDENCE: The home have worked to improve activities since the quality assurance questionnaires feedback identified activities as an area for improvement. Two members of staff take responsibility for organising activities. Regular activities include craft, flower arranging, quizzes, outings, in house entertainment, bingo, reminiscence and religious services. The service users indicated that they would like to resume music and movement and it is understood that an application has been made for staff to undertake the relevant training. Derwent House DS0000035815.V308804.R01.S.doc Version 5.2 Page 13 There is a designated activities room which is situated upstairs and away from the main communal area of the building. A variety of crafts take place and on the day of inspection flower arranging was taking place. In the afternoon activities take place in the main lounges downstairs. Some staff members have recently been on activities training and are keen to put their learning into practice, particularlyideas related to personal programme planning. Ideally this would involve all staff working with service users developing their key worker role. There are now regular outings and the day before the inspection service users had been on a trip to Crich Tramway museum. Festivities such as Christmas and Easter are celebrated, as are other seasonal events. There is an amenities committee and minutes of the meeting were made available. The weekend prior to the inspection there had been a successful fund raising event. It was confirmed by service users and relatives that visitors to the home are welcomed. Most service users have contact with relatives and friends and some go out on a regular basis. Most service users lived locally and reflect the cultural background of the local area. Service users sometimes go out to local shops or into town, ‘I can go out by myself to the shops’, ‘my relatives are always made welcome’. Service users and relatives spoken to were complimentary about the standard of catering, and the choice of menus that are available. Derwent House DS0000035815.V308804.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are systems in place which promote Safeguarding Adults from abuse. A clear and accessible complaints procedure is in place ensuring service users can be confident that any issues raised would be acted on effectively and promptly. EVIDENCE: There is a corporate complaints procedure in place, although most relatives and service users prefer to raise issues on a more informal basis and would discuss difficulties with the manager. Derbyshire County Council has clear procedures for dealing with the safety of service users and safeguarding them from harm. Staff spoken to showed an awareness of safeguarding adults issues and would pass any concerns on to their line manager. Training in safeguarding adults has been provided for staff. One issue relating to safeguarding adults was discussed and it was felt that a regulation 37 should have been made in this particular case, although it is understood that the matter was resolved satisfactorily. Derwent House DS0000035815.V308804.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is generally reasonably maintained and provides service users with an attractive and homely place to live. EVIDENCE: The building provides service users with a comfortable and homely place to live, although it is a large building arranged on three floors. There are a range of lounges, some of which also have dining areas. There is a designated smoking area. There is an attractive garden where service users can sit in good weather. The home recently won a gardening competition, a suitable reward for a lot of effort that had been put in by staff and service users! The home is on three floors and is generally well maintained, although the corridors are now due for redecoration. Since the last inspection the home Derwent House DS0000035815.V308804.R01.S.doc Version 5.2 Page 16 have invested in replacing the front door, and redecorating some communal areas and 17 bedrooms. Several requirements were made at the last inspection in relation to the building. These involved the replacement of some external window frames, entrance door and kitchen door. The fascia still needs to be replaced, but this is being done the week following the inspection. Six mental bed frames have been replaced. The requirements relating to the environment highlighted at the last inspection have been met. Service users gave permission for their bedrooms to be seen, all were comfortable and had been personalised. There are four bathrooms. There is a bathroom and a shower room downstairs. On the first floor the assisted bath had broken down on the day of inspection but a request had been made for it to be repaired promptly. The bath in the upstairs bathroom is not being used at the moment because needs replacing. This needs to be done to ensure that service users are given choice and can take a bath or shower at a time of their choosing. All parts of the home seen on the day of inspection were clean and tidy, and this was also commented on by service users. Derwent House DS0000035815.V308804.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A trained and competent workforce are in place which generally meet the dependency needs of service users currently accommodated within the home. Service users benefit from being supported by a trained and competent staff team. Limitations on staff time can impact on the provision on quality time spent with service users. EVIDENCE: Staffing hours and rotas were discussed. The manager reported that, generally speaking, all shifts are covered. On the day of inspection there were thirtythree servcie users in residence. Staff report being very busy, particularly when getting service users up and putting them to bed. Bathtimes are sometimes rushed, and staff are not always able to spend quality time with service users. The personal service plans do not currently provide sufficient information to give accurate judgements on service users dependency levels, which should be taken into account when calculating staffing hours. However, the calibre of staff is very high, and staff are committed to providing a good service putting service users welfare first; thus explaining why the overall satisfaction levels of service users and relatives is still high. This has contibuted to this outcome area being Derwent House DS0000035815.V308804.R01.S.doc Version 5.2 Page 18 judged as ‘good’ at the time of inspection. The home are planning to recruit more relief staff and there are two permanent vacancies. A member of staff had been appointed but the home were waiting for Criminal Record Bureau checks to be returned before the member of staff could commence their induction. The provider’s human resource department do not undertake Povafirst checks, which could be used to ensure that staff members are not on the Pova register in order to enable the potential staff members to commence supervised induction at the home. A copy of advice regarding the recording of CRB applications was left at the home. Derbyshire County Council has made a commitment to staff training and most care staff are trained to NVQ2 or above. There is an ongoing programme of mandatory training and staff spoken to were enthusiastic about training and felt that they were offered good training opportunities. Three staff files were seen and had evidence of CRB checks and references. Derbyshire County Council has a thorough and detailed recruitment and selection procedure. Derwent House DS0000035815.V308804.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is suitably qualified and experienced although formal registration with the CSCI has not yet taken place. Staff demonstrate an awareness of their roles and responsibilities, thus ensuring the home is run in the best interests of service users. EVIDENCE: The manager is experienced and suitably qualified to run the home. The manager is relatively newly appointed. A number of management related issues were discussed on the day of inspection. Service users and relatives spoke positively about the manager, and felt confident that any matters raised Derwent House DS0000035815.V308804.R01.S.doc Version 5.2 Page 20 with her would be dealt with. Regular staff meetings take place and the minutes of these meetings were made available. The inspector was informed that the home is visited regularly by a representative of the registered person and copies of Regulation 26 visits were available, indicating that day to day matters are looked into, and action take where appropriate. It was noted that one item for action was improvement to personal service plans, which has also been highlighted at this inspection. There has been a quality assurance exercise which indicated that the majority of elements of the service provided at Derwent House were good. The results of the survey had been made available to service users. Areas for improvement had been clearly identified and included activities and trips out, which the home have subsequently worked to improve. Another area highlighted for improvement was individual treatment of service users (helping with independence and one to one time). It is anticipated that another quality assurance exercise will be undertaken in the near future. It is hoped that the quality assurance exercise will also include staff views on all aspects of the operation of the home; and that the results of both these exercises will be made available to the home promptly so that action plans can be drawn up. Regular meetings are held with the service users and the minutes were made available to the inspector. The inspector was informed that at present service users’ finances are kept in the safe and manual records kept which appears to work satisfactorily. Most staff said that they have regular supervision and evidence of this was seen on staff files. Information on maintenance and health and safety records was provided by the manager in the pre-inspection questionnaire and indicates that matters relating to health and safety are generally satisfactory. However, the home did not have an up to date electrical hard wiring certificate, although it is understood that a survey has been done and identified some matters that need attention. The Environmental Health Officer had visited and brought several minor matters to the attention of the home and these had been dealt with in a timely manner. Derwent House DS0000035815.V308804.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 4 1 X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 3 Derwent House DS0000035815.V308804.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP31 Regulation 8 Requirement The appointed manager must apply to register with the CSCI. Timescale for action 01/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The home should ensure that assessments on prospective residents are completed in sufficient detail prior to admission to ensure that all aspects of a resident’s care can be met. Personal service plans should be completed in sufficient detail to instruct staff on how care is to be provided for each individual resident, including a daily programme; and personal service plans should be updated at regular intervals and after reviews to ensure that residents’ changing needs are fully documented. Care planning files should be audited to ensure that all documentation has been completed and is up to date and reflects current dependency levels. DS0000035815.V308804.R01.S.doc Version 5.2 Page 23 2 OP7 3 OP7 Derwent House 4 5 6 7 OP7 OP9 OP11 OP12 A copy of each of resident’s contracts should be kept on their files. Matters relating to recording medication administration as identified in the last report of supplying pharmacist should be complied with. The Home should consider ways of determining residents wishes around funeral arrangements and record appropriately. The activities programme should continue to be developed and care taken that this involves all residents and all staff, and does not impact on the quality of resident care. Regulation 37 notices should be completed and forwarded to the CSCI on any matters that adversely affects the wellbeing or safety of any service user. Decoration of the hall and ‘making good’ where items have been removed in toilets, and where new windows/doors have been put in should take place. The bath in the upstairs bathroom should be replaced and the assisted bath should be repaired to provide comfort and choice for service users. More relief staff should be recruited. A review of staffing hours should take place to ensure that the allocation of hours takes account of dependency levels, the size of the building, the allocation of short term care placements, and that staffing is on a par with registered numbers. A copy of the electrical hardwiring certificate should be kept at the home and a plan of action drawn up to address any shortfalls. 8 9 10 11 12 OP18 OP19 OP21 OP27 OP27 13 OP38 Derwent House DS0000035815.V308804.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Derwent House DS0000035815.V308804.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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